<h1>Edit Details</h1>

<?php
// echo '<br><pre>';
// print_r($this->userData);
// echo '</pre>';
?>
<form action="/main/profile/editpost" name="edit_profile" id="edit_profile" method="post">
    <input name="uid" type="hidden" value="<?php  echo  $this->userData->uid     ?>">
    <div class="clearfix column_wrapp">
        <div class="frm_row">
            <label for="UserEmail" class="required">Email</label>
            <input type="text" name="UserEmail" id="UserEmail" value="<?php  echo  $this->userData->UserEmail   ?>" class="validate[required, custom[email]] frmInput">
        </div>

        <div class="frm_row">
            <label for="Salutation" class="required">Salutation</label>
            <input type="text" name="Salutation" id="Salutation" value="<?php  echo  $this->userData->Salutation   ?>" class="frmInput">
        </div>

        <div class="frm_row">
            <label for="FirstName" class="required">First Name</label>
            <input type="text" name="FirstName" id="FirstName" value="<?php  echo  $this->userData->FirstName   ?>" class="validate[required,maxSize[20] ] frmInput">
        </div>

        <div class="frm_row">
            <label for="MiddleName">Middle Name</label>
            <input type="text" name="MiddleName" id="MiddleName" value="<?php  echo  $this->userData->MiddleName   ?>" class="validate[maxSize[20] ] frmInput">
        </div>

        <div class="frm_row">
            <label for="LastName" class="required">Last Name</label>
            <input type="text" name="LastName" id="LastName" value="<?php  echo  $this->userData->LastName   ?>" class="validate[required,maxSize[20] ] frmInput">
        </div>


        <div class="frm_row">
            <label for="PreviousFirstName" class="required">Previous First Name</label>
            <input type="text" name="PreviousFirstName" id="PreviousFirstName" value="<?php  echo  $this->userData->PreviousFirstName   ?>" class="validate[maxSize[20] ] frmInput">
        </div>

        <div class="frm_row">
            <label for="PreviousMiddleName">PreviousMiddleName</label>
            <input type="text" name="PreviousMiddleName" id="PreviousMiddleName" value="<?php  echo  $this->userData->PreviousMiddleName   ?>" class="validate[maxSize[20] ] frmInput">
        </div>

        <div class="frm_row">
            <label for="PreviousLastName" class="required">Previous Last Name</label>
            <input type="text" name="PreviousLastName" id="PreviousLastName" value="<?php  echo  $this->userData->PreviousLastName   ?>" class="validate[maxSize[20] ] frmInput">
        </div>

        <div class="frm_row">
            <label for="DateOfBirth" class="required">Date Of Birth</label>
            <input type="text" name="DateOfBirth" id="DateOfBirth" value="<?php  echo $this->userData->DateOfBirth   ?>" class="validate[required, custom[date] ] frmInput">
        </div>

        <div class="frm_row">
            <label for="PlaceOfBirth" class="required">Place Of Birth</label>
            <input type="text" name="PlaceOfBirth" id="PlaceOfBirth" value="<?php  echo  $this->userData->PlaceOfBirth   ?>" class="validate[maxSize[35] ] frmInput">
        </div>

        <div class="frm_row">
            <label for="Gender" class="required">Gender</label>
            <select name="Gender" class="validate[required] frmInput">
                <option value="" >Choose...</option>
                <option value="1" >Male</option>
                <option value="2" >Female</option>
            </select>
        </div>

        <div class="frm_row">
            <label for="PhysicalIdentityMark">Physical Identity Mark</label>
            <!-- <textarea name="PhysicalIdentityMark" id="PhysicalIdentityMark" cols="5" rows="4" class="fmrtextArea"><?php  echo  $this->userData->PhysicalIdentityMark   ?> </textarea> -->
            <input type="text" name="PhysicalIdentityMark" id="PhysicalIdentityMark" value="<?php  echo  $this->userData->PhysicalIdentityMark   ?>" class="frmInput">
        </div>

        <div class="frm_row">
            <label for="PermanentAccountNumber">Permanent Account Number</label>
            <input type="text" name="PermanentAccountNumber" id="PermanentAccountNumber" value="<?php  echo  $this->userData->PermanentAccountNumber  ?>" class="validate[required, maxSize[10] ] frmInput">
        </div>

        <div class="frm_row">
            <label for="Qualification">Qualification</label>
            <input type="text" name="Qualification" id="Qualification" value="<?php  echo  $this->userData->Qualification   ?>" class="frmInput">
        </div>

        <div class="frm_row">
            <label for="Occupation">Occupation</label>
            <input type="text" name="Occupation" id="Occupation" value="<?php  echo  $this->userData->Occupation   ?>" class="frmInput">
        </div>

        <div class="frm_row">
            <label for="RecentPhoto">Recent Photo</label>
            <input type="file" name="RecentPhoto" id="RecentPhoto" value="<?php  echo  $this->userData->RecentPhoto   ?>" class="frmInput">
        </div>

        <div class="frm_row">
            <label for="PhysicallyChallenged">Physically Challenged</label>
            <select name="PhysicallyChallenged" class="validate[required] frmInput">
                <option value="" >Choose...</option>
                <option value="1" >YES</option>
                <option value="2" >NO</option>
            </select>
        </div>

        <div class="frm_row">
            <label for="PhysicallyChallengedDescription">Physically Challenged Description</label>
            <textarea name="PhysicallyChallengedDescription" id="PhysicallyChallengedDescription" cols="5" rows="4" class="fmrtextArea"><?php  echo  $this->userData->PhysicallyChallengedDescription   ?> </textarea>
        </div>

         <div class="frm_row">
            <label for="RecentPhoto">Mobile Number</label>
            <input type="text" name="MobileNumber" id="MobileNumber" value="<?php  echo  $this->userData->MobileNumber   ?>" class="validate[required, custom[phone] ,maxSize[10] frmInput">
        </div>

         <div class="frm_row">
            <label for="BestPhoneToReach">Best Phone To Reach</label>
            <input type="text" name="BestPhoneToReach" id="BestPhoneToReach" value="<?php  echo  $this->userData->MobileNumber   ?>" class="validate[required, custom[phone],maxSize[10] frmInput">
        </div>

        <div class="frm_row">
            <label for="AlternateEmail" class="required">Alternate Email</label>
            <input type="text" name="AlternateEmail" id="AlternateEmail" value="<?php  echo  $this->userData->AlternateEmail   ?>" class="validate[custom[email]] frmInput">
        </div>

       <div class="frm_row">
            <label for="TermsOfEmployment">Terms Of Employment</label>
            <textarea name="TermsOfEmployment" id="TermsOfEmployment" cols="5" rows="4" class="fmrtextArea"><?php  echo  $this->userData->TermsOfEmployment   ?> </textarea>
        </div>
        
       <div class="frm_row">
            <label for="FamilyDisclosure">Family Disclosure</label>
            <!-- <textarea name="FamilyDisclosure" id="FamilyDisclosure" cols="5" rows="4" class="fmrtextArea"><?php  echo  $this->userData->FamilyDisclosure   ?> </textarea> -->
            <select name="FamilyDisclosure" class="validate[required] frmInput">
                <option value="" >Choose...</option>
                <option value="1" >YES</option>
                <option value="2" >NO</option>
            </select>
        </div>

       <div class="frm_row">
            <label for="FuneralRequests">FuneralRequests</label>
            <textarea name="FuneralRequests" id="FuneralRequests" cols="5" rows="4" class="fmrtextArea"><?php  echo  $this->userData->FuneralRequests   ?> </textarea>
        </div>

        <div class="frm_row">
            <input type="submit" value="Save Info" class="submitBtn">
        </div>

    </div>
</form>

<script type="text/javascript">
        jQuery(document).ready(function(){
            jQuery("#edit_profile").validationEngine();
        });
</script>
